Controlling Your Bowels!

Controlling Your Bowels!

By: Massarat Zutshi, MD • Posted on April 10, 2014


Female Bowel Habits

Normal bowel habits are not typically a popular topic for discussion. However, this is an important topic that women should be discussing.

Female bowel habits cannot be classified easily, as changes throughout our life cycle tend to have an effect on bowel movements. The following bowel concerns can have a significant effect on one's life:

  • Irritable Bowel Syndrome
  • Diarrhea.
  • Constipation
  • Food allergies
  • Hemorrhoids

Fecal Incontinence

Uncontrolled loss of stool and gas is medically termed “fecal incontinence” and is a symptom that isn't a pointer to any life threatening disease. However, fecal incontinence can make the life of the person who suffers from it very incapacitating. This condition affects females and males, but is more common in the female population. Many sufferers of this condition do not seek help because they do not want people to know or are ashamed to tell their primary care physician. This is nothing to be ashamed about and there are several treatment options!

The most common cause of fecal leakage in women is from injury during childbirth. Other causes include:

  • Trauma
  • Surgery to the anal canal
  • Normal aging of the muscles

Fecal leakage/incontinence can be graded as mild, moderate or severe depending on the frequency of symptoms.

Mild Incontinence

Mild incontinence is usually the inability to control gas with an occasional stain in the underwear or incontinence with loose bowel movements.

Moderate Incontinence

Moderate incontinence is at least 3-5 accidents a month.

Severe Incontinence

Severe incontinence is loss of control many times a day.

Tips to Help Manage your Bowel Movements

Managing your bowel movements start with the following:

  • Diet modifications
  • Kegel exercises
  • Addition of a bulk laxative like a fiber supplement

All women should be taught how to do Kegel exercises correctly, preferably before childbirth. Many women are aware of urinary leakage problems, which are usually discussed but may be less familiar with the problem of fecal/stool incontinence.

Fecal Incontinence Treatments

There are some new and innovative methods for treating this rather debilitating disease. Therapy always begins with bowel evaluation, lifestyle changes and certain oral bulking agents, like pectin, if indicated. When lifestyle options are not enough and a person does not want to go straight for anal sphincter surgery, there are other intermediate and acceptable therapies that many women and their physicians may not yet know about. Those therapies include:

  1. SECCA Procedure. This procedure involves radiofrequency stimulation of the tissue in and around the anal sphincter, which stimulates the formation of collagen in the tissue leading to an increase in the tone of the anal sphincter muscle. It is an outpatient procedure done under sedation and local anesthesia. Results are seen after three to four months and improvements continue for six months. No significant complications have been reported.
  2. Solesta Injectable Therapy. It involves injection of a liquid solution, hyaluronic acid, in the area of the anal sphincter muscle. These office injections, which take about five minutes act as a bulking agent and help in treatment by closing the anal orifice and bulking the sphincter which prevents stool leakage. This is offered as an outpatient procedure and is relatively painless. Repeat injections at three months can be done if needed.
  3. Sacral Nerve Stimulator. Newer advances in neuromodulation have made this procedure available for fecal incontinence. It works by constantly stimulating the nerves, which supply the anal sphincter muscle which are the sacral nerves..
  4. Non-Invasive Treatment. The InToneMV device is FDA approved and the latest, non-invasive treatment for fecal incontinence.

Treatment of Severe Fecal Incontinence

Very severe fecal incontinence with very low muscle tone can be treated with the artificial bowel sphincter. The procedure is done in the operating room by colorectal specialists, and patients are kept in the hospital for three to four days. Alternatively, a stoma can be surgically created.

Although creation of a stoma and wearing of a bag seem drastic for a benign disease, it is often a way for patients to be freed from a toilet-bondage. Stoma is offered when no other form of treatment can offer a cure. However, the above options, early evaluation and treatment as well as prevention is always our first line of defense.

Summary

Bowel management is essential for good bowel control. The treatment of fecal incontinence has come a long way. From only one or two options to many and still more coming in, it gives us hope to be able to reach out to many people and treat this otherwise debilitating condition.

Be Strong. Be Healthy. Be in Charge!

Massarat Zutshi, MD
Cleveland Clinic Colorectal Surgeon
A30 Cleveland Clinic Foundation
Cleveland, OH 44195
Call 216.445.9456 to make an appointment with Dr. Massarat Zutshi


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